Clinical effectiveness of combined interventional therapy as a salvage modality for unresectable pancreatic carcinoma

Das,Sushant  Kumar; Wang,Jin  Liang; Li,Bing; Zhang,Chuan; Yang,Han  Feng

doi:10.3892/ol.2019.10323

Clinical effectiveness of combined interventional therapy as a salvage modality for unresectable pancreatic carcinoma

Authors:
- Sushant Kumar Das
- Jin Liang Wang
- Bing Li
- Chuan Zhang
- Han Feng Yang
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Affiliations: Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China, Department of Radiology, Pingdingshan Fifth People's Hospital, Pingdingshan, Henan 467000, P.R. China
Published online on: May 6, 2019 https://doi.org/10.3892/ol.2019.10323
Pages: 375-385

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Abstract

Although different treatment methods have been introduced to treat advanced pancreatic carcinoma, the median overall survival rate remains unsatisfactory. Theoretically, combining different treatment methods should work in synergy to enhance locoregional disease control and improve survival. Therefore, the aim of the present retrospective study was to analyze the effectiveness of combined interventional therapy compared with trans‑arterial chemoembolization (TACE) or chemotherapy alone for the treatment of unresectable pancreatic carcinoma. A total of 266 patients who were undergoing treatment for unresectable pancreatic carcinoma between July 2012 and November 2015 were included in the current study. The tumor responses and 3‑year overall survival rates of patients treated with combined interventional therapy (TACE combined with iodine‑125 seed implantation and/or radiofrequency ablation; CIT group; n=84) were compared with those of patients treated with TACE alone (TACE group; n=59), as well as patients treated with systemic chemotherapy alone (control group; n=123). Patients in the CIT group exhibited significantly improved tumor responses compared with patients in the TACE group (51.89 vs. 30.61%; P=0.028) or control group (51.89 vs. 17.20%; P<0.001). The 3‑year overall survival rate of the CIT group was also significantly higher compared with that of the TACE and control groups (P=0.0116 and P=0.0001, respectively). Furthermore, the CIT group exhibited a significantly higher overall survival rate for patients with unresectable metastatic pancreatic cancer compared with the TACE and control groups (P=0.0088 and P<0.0001, respectively), which suggests that a combination of different interventional techniques increases the survival of patients with unresectable pancreatic cancer. No life‑threatening complications were observed in any treatment group. In conclusion, combined interventional therapy exhibits a good efficacy and an improved survival rate for unresectable pancreatic cancer compared with TACE alone.

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1	Siegel R, Ma J, Zou Z and Jemal A: Cancer statistics, 2014. CA Cancer J Clin. 64:9–29. 2014. View Article : Google Scholar : PubMed/NCBI
2	Zhang L, Jin H, Guo X, Yang Z, Zhao L, Tang S, Mo P, Wu K, Nie Y Pan Y and Fan D: Distinguishing pancreatic cancer from chronic pancreatitis and healthy individuals by (1) H nuclear magnetic resonance-based metabonomic profiles. Clin Biochem. 45:1064–1069. 2012. View Article : Google Scholar : PubMed/NCBI
3	Li D, Xie K, Wolff R and Abbruzzese JL: Pancreatic cancer. Lancet. 363:1049–1057. 2004. View Article : Google Scholar : PubMed/NCBI
4	Siegel R, Naishadham D and Jemal A: Cancer statistics, 2012. CA Cancer J Clin. 62:10–29. 2012. View Article : Google Scholar : PubMed/NCBI
5	Mao C, Domenico DR, Kim K, Hanson DJ and Howar JM: Observations on the developmental patterns and the consequences of pancreatic exocrine adenocarcinoma: Findings of 154 autopsies. Arch Surg. 130:125–134. 1995. View Article : Google Scholar : PubMed/NCBI
6	Kamisawa T, Isawa T, Koike M, Tsuruta K and Okamoto A: Hematogenous metastases of pancreatic ductal carcinoma. Pancreas. 11:345–349. 1995. View Article : Google Scholar : PubMed/NCBI
7	Iacobuzio-Donahue CA, Fu B, Yachida S, Luo M, Abe H, Henderson CM, Vilardell F, Wang Z, Keller JW, Banerjee P, et al: DPC4 gene status of the primary carcinoma correlates with patterns of failure in patients with pancreatic cancer. J Clin Oncol. 27:1806–1813. 2009. View Article : Google Scholar : PubMed/NCBI
8	Frigerio I, Girelli R, Giardino A, Regi P, Salvia R and Bassi C: Short term chemotherapy followed by radiofrequency ablation in stage III pancreatic cancer: Results from a single center. J Hepatobiliary Pancreat Sci. 20:574–577. 2013. View Article : Google Scholar : PubMed/NCBI
9	Girelli R, Frigerio I, Salvia R, Barbi E, Tinazzi Martini P and Bassi C: Feasibility and safety of radiofrequency ablation for locally advanced pancreatic cancer. Br J Surg. 97:220–225. 2010. View Article : Google Scholar : PubMed/NCBI
10	Keane MG, Bramis K, Pereira SP and Fusai GK: Systematic review of novel ablative methods in locally advanced pancreatic cancer. World J Gastroenterol. 20:2267–2278. 2014. View Article : Google Scholar : PubMed/NCBI
11	Spiliotis JD, Datsis AC, Michalopoulos NV, Kekelos SP, Vaxevanidou A, Rogdakis AG and Christopoulou AN: Radiofrequency ablation combined with palliative surgery may prolong survival of patients with advanced cancer of the pancreas. Langenbecks Arch Surg. 392:55–60. 2007. View Article : Google Scholar : PubMed/NCBI
12	Matsui Y, Nakagawa A, Kamiyama Y, Yamamoto K, Kubo N and Nakase Y: Selective thermocoagulation of unresectable pancreatic cancers by using radiofrequency capacitive heating. Pancreas. 20:14–20. 2000. View Article : Google Scholar : PubMed/NCBI
13	Date RS and Siriwardena AK: Radiofrequency ablation of the pancreas. II: Intra-operative ablation of non-resectable pancreatic cancer. A description of technique and initial outcome. JOP. 6:588–592. 2005.PubMed/NCBI
14	Landman J: Differences in immunologic response to cryoablation versus radiofrequency ablation in the treatment of renal cell carcinoma. ClinicalTrial, RCT No. NCT03409224. 2018.
15	Rombouts SJ, Vogel JA, van Santvoort HC, van Lienden KP, van Hillegersberg R, Busch OR, Besselink MG and Molenaar IQ: Systematic review of innovative ablative therapies for the treatment of locally advanced pancreatic cancer. Br J Surg. 102:182–193. 2015. View Article : Google Scholar : PubMed/NCBI
16	Wu PH, Pan CC, Huang ZL, Li W, Zhao M and Zhou ZW: Percutaneous radiofrequency ablation approach through the spleen: Initial case report for pancreatic tail gastrinoma. Chin J Cancer. 29:836–841. 2010. View Article : Google Scholar : PubMed/NCBI
17	Paiella S, Salvia R, Girelli R, Frigerio I, Giardino A, D'Onofrio M, De Marchi G and Bassi C: Role of local ablative techniques (radiofrequency ablation and irreversible electroporation) in the treatment of pancreatic cancer. Updates Surg. 68:307–311. 2016. View Article : Google Scholar : PubMed/NCBI
18	Yu YP, Yu Q, Guo JM Jiang HT, Di XY and Zhu Y: Effectiveness and security of CT-guided percutaneous implantation of 125I seeds in pancreatic carcinoma. Br J Radiol. 87:201306422014. View Article : Google Scholar : PubMed/NCBI
19	Vogl TJ, Mohamed SA, Albrecht MH, Gruber-Roh T, Lin H, Nour Eldin NEA, Bednarova I, Naguib NN and Panahi B: Transarterial chemoembolization in pancreatic adenocarcinoma with liver metastases: MR-based tumor response evaluation, apparent diffusion coefficient (ADC) patterns, and survival rates. Pancreatology. 18:94–99. 2018. View Article : Google Scholar : PubMed/NCBI
20	Ceha HM, van Tienhoven G, Gouma DJ, Veenhof CH, Schneider CJ, Rauws EA, Phoa SS and González González D: Feasibility and efficacy of high dose conformal radiotherapy for patients with locally advanced pancreatic carcinoma. Cancer. 89:2222–2229. 2000. View Article : Google Scholar : PubMed/NCBI
21	Du YQ, Li ZS and Jin ZD: Endoscope-assisted brachytherapy for pancreatic cancer: From tumor killing to pain relief and drainage. J Interv Gastroenterol. 1:23–27. 2011. View Article : Google Scholar : PubMed/NCBI
22	Paulsen SD, Nghiem HV, Negussie E, Higgins EJ, Caoili EM and Francis IR: Evaluation of imaging-guided core biopsy of pancreatic masses. AJR Am J Roentgenol. 187:769–772. 2006. View Article : Google Scholar : PubMed/NCBI
23	Smith EH: Complications of percutaneous abdominal fine-needle biopsy. Review. Radiology. 178:253–258. 1991. View Article : Google Scholar : PubMed/NCBI
24	Vogl TJ, Zangos S, Heller M, Hammerstingl RM, Böcher E, Jacob U and Bauer RW: Transarterial chemoperfusion with gemcitabine and mitomycin c in pancreatic carcinoma: Results in locally recurrent tumors and advanced tumor stages. Rofo. 179:1181–1188. 2007.(In German). View Article : Google Scholar : PubMed/NCBI
25	Huang ZM, Pan CC, Wu PH, Zhao M, Li W, Huang ZL and Yi RY: Efficacy of minimally invasive therapies on unresectable pancreatic cancer. Chin J Cancer. 32:334–341. 2013. View Article : Google Scholar : PubMed/NCBI
26	Lencioni R and Llovet JM: Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 30:52–60. 2010. View Article : Google Scholar : PubMed/NCBI
27	Karnofsky DA and Burchenal JH: Evaluation of chemotherapeutic agents. The Clinical Evaluation of Chemotherapeutic Agents in Cancer. Macleod CM: Columbia University Press. (New York, NY). p2051949.
28	Liu X, Yang X, Zhou G, Chen Y, Li C and Wang X: Gemcitabine-based regional intra-arterial infusion chemotherapy in patients with advanced pancreatic adenocarcinoma. Medicine (Baltimore). 95:e30982016. View Article : Google Scholar : PubMed/NCBI
29	Long J, Luo GP, Xiao ZW, Liu ZQ, Guo M, Liu L, Liu C, Xu J, Gao YT, Zheng Y, et al: Cancer statistics: Current diagnosis and treatment of pancreatic cancer in Shanghai, China. Cancer Lett. 346:273–277. 2014. View Article : Google Scholar : PubMed/NCBI
30	Seldinger SI: Catheter replacement of the needle in percutaneous arteriography; A new technique. Acta Radiol. 39:368–376. 1953. View Article : Google Scholar : PubMed/NCBI
31	Wu ZX, Yang XZ, Cai JQ, Liao LM, Yang L, Lin YN and Tan JM: Digital subtraction angiography and computed tomography angiography of predominant artery feeding pancreatic body and tail. Diabetes Technol Ther. 13:537–541. 2011. View Article : Google Scholar : PubMed/NCBI
32	Donatini B: A systematic study of the vascularisation of the pancreas. Surg Radiol Anat. 12:173–180. 1990. View Article : Google Scholar : PubMed/NCBI
33	‘Pain Intensity Instruments’, . National Institutes of Health - Warren Grant Magnuson Clinical Center. July;2003.http://mvltca.net/Presentations/mvltca.pdfAugust 5–2018
34	Wang H, Wang J, Jiang Y, Li J, Tian S, Ran W, Xiu D and Gao Y: The investigation of 125I seed implantation as a salvage modality for unresectable pancreatic carcinoma. J Exp Clin Cancer Res. 32:1062013. View Article : Google Scholar : PubMed/NCBI
35	Common terminology criteria for adverse events (version 4.0). https://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03/Archive/CTCAE_4.0_2009-05-29_QuickReference_8.5×11.pdfAugust 19–2018
36	Morin E, Cheng S, Mete O, Serra S, Araujo PB, Temple S, Cleary S, Gallinger S, Greig PD, McGilvray I, et al: Hormone profiling, WHO 2010 grading, and AJCC/UICC staging in pancreatic neuroendocrine tumor behavior. Cancer Med. 2:701–711. 2013.PubMed/NCBI
37	Vincent A, Herman J, Schulick R, Hruban RH and Goggins M: Pancreatic cancer. Lancet. 378:607–620. 2011. View Article : Google Scholar : PubMed/NCBI
38	Saif MW: New developments in the treatment of pancreatic cancer. highlights from the ‘44th ASCO annual meeting’. Chicago, IL, USA. May 30-June 3, 2008. JOP. 9:391–397. 2008.PubMed/NCBI
39	Wang J, Wang J, Liao A, Zhuang H and Zhao Y: The direct biologic effects of radioactive 125I seeds on pancreatic cancer cells PANC-1, at continuous low-dose rates. Cancer Biother Radiopharm. 24:409–416. 2009. View Article : Google Scholar : PubMed/NCBI
40	Cron GO, Beghein N, Crokart N, Chavée E, Bernard S, Vynckier S, Scalliet P and Gallez B: Changes in the tumor microenvironment during low-dose-rate permanent seed implantation iodine-125 brachytherapy. Int J Radiat Oncol Biol Phys. 63:1245–1251. 2005. View Article : Google Scholar : PubMed/NCBI
41	Nikfarjam M, Muralidharan V and Christophi C: Mechanisms of focal heat destruction of liver tumors. J Surg. Res. 127:208–223. 2005.
42	Teng LS, Jin KT, Han N and Cao J: Radiofrequency ablation, heat shock protein 70 and potential anti-tumor immunity in hepatic and pancreatic cancers: A minireview. Hepatobiliary Pancreat Dis Int. 9:361–365. 2010.PubMed/NCBI
43	Dromi SA, Walsh MP, Herby S, Traughber B, Xie J, Sharma KV, Sekhar KP, Luk A, Liewehr DJ, Dreher MR, et al: Radiofrequency ablation induces antigen-presenting cell infiltration and amplification of weak tumor-induced immunity. Radiology. 251:58–66. 2009. View Article : Google Scholar : PubMed/NCBI
44	Fegrachi S, Besselink MG, van Santvoort HC, van Hillegersberg R and Molenaar IQ: Radiofrequency ablation for unresectable locally advanced pancreatic cancer: A systematic review. HPB (Oxford). 16:119–123. 2014. View Article : Google Scholar : PubMed/NCBI
45	Son SH, Song JH, Choi BO, Kang YN, Lee MA, Kang KM and Jang HS: The technical feasibility of an image-guided intensity-modulated radiotherapy (IG-IMRT) to perform a hypofractionated schedule in terms of toxicity and local control for patients with locally advanced or recurrent pancreatic cancer. Radiat Oncol. 7:2032012. View Article : Google Scholar : PubMed/NCBI